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Cleft Palate Repair With Gum Ridge Bone Graft

North Dakota rates for HCPCS 42210

Closes a cleft in the roof of the mouth and rebuilds the gap in the gum ridge that holds the teeth, using a piece of the patient's own bone taken during the same operation. Filling the gum ridge gives the teeth a base to sit in and supports the shape of the upper jaw. It is usually done in childhood, timed around dental development.

Rates data updated July 2026.

Facilitymedian $1,096 · 10th–90th $1,000$8,5110%50%10th90th$1,096Professionalmedian $2,089 · 10th–90th $1,000$2,8180%10%10th90th$2,089$1.0K$2.0K$5.0K$10.0K

Distribution of negotiated rates across all payers (price axis is log-scale). Facility and professional rates are different services and are charted separately. Need provider-level prices? Contact us.

Insurance Carrier
Aetna
Setting
Facility
Modifier
Global
Typical Low
$1,000.00
Median
$1,096.48
Typical High
$8,511.38
Aetna
Setting
Professional
Modifier
Global
Typical Low
$977.24
Median
$1,096.48
Typical High
$2,884.03
BCBS
Setting
Professional
Modifier
Global
Typical Low
$1,905.46
Median
$2,344.23
Typical High
$2,818.38
Cigna
Setting
Professional
Modifier
Global
Typical Low
$1,148.15
Median
$1,995.26
Typical High
$3,090.30
Medica
Setting
Facility
Modifier
Global
Typical Low
$1,096.48
Median
$1,548.82
Typical High
$2,818.38
Medica
Setting
Professional
Modifier
Global
Typical Low
$977.24
Median
$1,778.28
Typical High
$11,481.54
United
Setting
Facility
Modifier
Global
Typical Low
$2,818.38
Median
$7,943.28
Typical High
$11,748.98
United
Setting
Professional
Modifier
Global
Typical Low
$912.01
Median
$1,445.44
Typical High
$2,570.40